Skip to main content
SpringerLink
Log in

Correlation of blood pressure, obesity, and adherence to the Mediterranean diet with indices of arterial stiffness in children

  • Original Article
  • Published:
European Journal of Pediatrics Aims and scope Submit manuscript

Abstract

The aim of the study was to assess the hypothesis that obesity, blood pressure (BP), and dietary habits (adherence to the Mediterranean diet) are related to indices of arterial stiffness (AS) in childhood. Two hundred and seventy-seven children aged 12 years were measured with the R6.5 Pulsecor® monitor, which performs measurements using an upper arm BP cuff held at above systolic pressure for a short time. The augmentation index (AI) in the brachial artery, the peripheral pulse pressure to central pulse pressure (PPP/CPP) ratio, and the reflected wave transit time to height ratio were used as indices of AS. The degree of adherence to the Mediterranean diet was assessed by the KIDMED index which includes 16 questions on specific dietary habits. Forty-three percent of the children were overweight and obese. Overweight and obese children had significantly lower PPP/CPP and KIDMED score in comparison to children with normal body mass index (BMI). In multivariate regression models, indices of AS were related to mean peripheral BP, heart rate, and height, while BMI had an independent correlation to PPP/CPP. The KIDMED index also had a negative correlation with AI independently of obesity. Conclusion: Obesity and adherence to the Mediterranean diet patterns are factors related independently to indices of AS even in 12-year-old children.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Aatola H, Koivistoinen T, Hutri-Kähönen N, Juonala M, Mikkilä V, Lehtimäki T, Viikari JS, Raitakari OT, Kähönen M (2010) Lifetime fruit and vegetable consumption and arterial pulse wave velocity in adulthood: the Cardiovascular Risk in Young Finns Study. Circulation 122:2521–2528

    Article  PubMed  Google Scholar 

  2. Aggoun Y, Farpour-Lambert NJ, Marchand LM, Golay E, Maggio AB, Beghetti M (2008) Impaired endothelial and smooth muscle functions and arterial stiffness appear before puberty in obese children and are associated with elevated ambulatory blood pressure. Eur Heart J 29:792–799

    Article  PubMed  Google Scholar 

  3. Ahimastos AA, Formosa M, Dart AM, Kingwell BA (2003) Gender differences in large artery stiffness pre- and post puberty. J Clin Endocrinol Metab 88:5375–5380

    Article  PubMed  CAS  Google Scholar 

  4. Angelopoulos PD, Milionis HJ, Moschonis G, Manios Y (2006) Relations between obesity and hypertension: preliminary data from a cross-sectional study in primary schoolchildren: the children study. Eur J Clin Nutr 60:1226–1234

    Article  PubMed  CAS  Google Scholar 

  5. Ayer JG, Harmer JA, Marks GB, Avolio A, Celermajer DS (2010) Central arterial pulse wave augmentation is greater in girls than boys, independent of height. J Hypertens 28:306–313

    Article  PubMed  CAS  Google Scholar 

  6. Bjarnegard N, Lanne T (2010) Arterial properties along the upper arm in humans: age-related effects and the consequence of anatomical location. J Appl Physiol 108:34–38

    Article  PubMed  Google Scholar 

  7. Cole TJ, Bellizzi MC, Flegal KM, Dietz WH (2000) Establishing a standard definition for child overweight and obesity worldwide: international survey. BMJ 320:1240–1243

    Article  PubMed  CAS  Google Scholar 

  8. Collins RT, Somes GW, Alpert BS (2008) Differences in arterial compliance among normotensive adolescent groups: Collins arterial compliance in adolescents. Pediatr Cardiol 29:929–934

    Article  PubMed  Google Scholar 

  9. De Backer G, Ambrosioni E, Borch-Johnsen K, Brotons C, Cifkova R, Dallongeville J, Ebrahim S, Faergeman O, Graham I, Mancia G, Manger Cats V, Orth-Gomér K, Perk J, Pyorälä K, Rodicio JL, Sans S, Sansoy V, Sechtem U, Silber S, Thomsene T, Wood D (2003) European guidelines on cardiovascular disease prevention in clinical practice (constituted by representatives of eight societies and by invited experts). Third joint task force of European and other societies on cardiovascular disease prevention in clinical practice. Eur J Cardiovasc Prev Rehabil 10:S1–S10

    Article  PubMed  Google Scholar 

  10. Farajian P, Risvas G, Karasouli K, Pounis G, Kastorini CM, Panagiotakos DB, Zampelas A (2011) Very high childhood obesity prevalence and low adherence rates to the Mediterranean diet in Greek children: the GRECO study. Atherosclerosis 217:525–530

    Article  PubMed  CAS  Google Scholar 

  11. Im JA, Lee JW, Shim Y, Lee HR, Lee DC (2007) Association between brachial-ankle pulse wave velocity and cardiovascular risk factors in healthy adolescents. J Pediatr 150:247–251

    Article  PubMed  Google Scholar 

  12. Juonala M, Jarvisalo MJ, Maki-Torkko N, Kahonen M, Viikari JS, Raitakari OT (2005) Risk factors identified in childhood and decreased carotid artery elasticity in adulthood: the Cardiovascular Risk in Youth Finns Study. Circulation 112:1486–1493

    Article  PubMed  Google Scholar 

  13. Kant AK, Graubard BI (2006) Secular trends in patterns of self-reported food consumption of adult Americans: NHANES 1971–1975 to NHANES 1999–2002. Am J Clin Nutr 84:1215–1223

    PubMed  CAS  Google Scholar 

  14. Keys A, Aravanis C, Blackburn HW (1966) Epidemiological studies related to coronary heart disease: characteristics of men aged 40–59 in seven countries. Acta Med Scand Suppl 460:1–392

    PubMed  CAS  Google Scholar 

  15. Kollias K, Skliros E, Leotsakos N, Gikas A, Garifallos D (2009) Childhood obesity in relation to parental weight status in Greece. Hippokratia 13:253

    PubMed  CAS  Google Scholar 

  16. Lazarou C, Panagiotakos DB, Matalas AL (2009) Level of adherence to the Mediterranean diet among children from Cyprus: the CYKIDS study. Public Health Nutr 12:991–1000

    Article  PubMed  Google Scholar 

  17. Linardakis E, Vardavas K, Kafatos A (2007) Waist circumference percentiles of children in Crete aged 3 to 16 years. Pediatriki 70:300–307

    Google Scholar 

  18. Lobstein T, Frelut ML (2003) Prevalence of overweight in Europe. Obes Rev 4:195–200

    Article  PubMed  CAS  Google Scholar 

  19. Lowe A, Harrison W, El-Aklouk E, Ruygrok P, Al-Jumaily AM (2009) Non-invasive model-based estimation of aortic pulse pressure using suprasystolic brachial pressure waveforms. J Biomech 42:2111–2115

    Article  PubMed  CAS  Google Scholar 

  20. Lurbe E, Cifkova R, Cruickshank JK, Dillon MJ, Ferreira I, Invitti C, Kuznetsova T, Laurent S, Mancia G, Morales-Olivas F, Rascher W, Redon J, Schaefer F, Seeman T, Stergiou G, Wühl E, Zanchetti A (2009) Management of high blood pressure in children and adolescents: recommendations of the European Society of Hypertension. J Hypertens 27:1719–1742

    Article  PubMed  CAS  Google Scholar 

  21. Lydakis C, Momen A, Blaha C, Gugoff S, Gray K, Herr M, Leuenberger UA, Sinoway L (2008) Changes of central haemodynamic parameters during mental stress and acute bouts of static and dynamic exercise. J Hum Hypertens 22:320–328

    Article  PubMed  CAS  Google Scholar 

  22. Miyai N, Arita M, Miyashita K, Morioka I, Takeda S (2009) The influence of obesity and metabolic risk variables on brachial-ankle pulse wave velocity in healthy adolescents. J Hum Hypertens 23:444–450

    Article  PubMed  CAS  Google Scholar 

  23. National High Blood Pressure Education Program Working Group on High Blood Pressure in Children and Adolescents (2004) The fourth report on the diagnosis, evaluation, and treatment of high blood pressure in children and adolescents. Pediatrics 114:555–576

    Article  Google Scholar 

  24. Niboshi A, Hamaoka K, Sakata K, Inoue F (2006) Characteristics of brachial-ankle pulse wave velocity in Japanese children. Eur J Pediatr 65:625–629

    Article  Google Scholar 

  25. Papadimitriou A, Konstantinidou M, Christopanou H, Xepapadaki P, Giannouli O, Nicolaidou P (2009) Secular trend in body height of schoolchildren in Northeast Attica, Greece. J Pediatr Endocrinol Metab 22:13–17

    Article  PubMed  CAS  Google Scholar 

  26. Park CM, March K, Ghosh AK, Tillin T, Mayet J, Lowe A, Chaturvedi N, Hughes AD (2010) A method comparison of central blood pressure measurements by PULSECOR and SphygmoCor Devices. Artery Res 4:171

    Article  Google Scholar 

  27. Sakuragi S, Abhayaratna K, Gravenmaker KJ, O'Reilly C, Srikusalanukul W, Budge MM, Telford RD, Abhayaratna WP (2009) Influence of adiposity and physical activity on arterial stiffness in healthy children: the lifestyle of our kids study. Hypertension 53:611–616

    Article  PubMed  CAS  Google Scholar 

  28. Schack-Nielsen L, Molgaard C, Larsen D, Martyn C, Michaelsen KF (2005) Arterial stiffness in 10-year-old children: current and early determinants. Br J Nutr 94:1004–1011

    Article  PubMed  CAS  Google Scholar 

  29. Serra-Majem L, Ribas L, Ngo J, Ortega RM, García A, Pérez-Rodrigo C, Aranceta J (2004) Food, youth and the Mediterranean diet in Spain. Development of KIDMED, Mediterranean Diet Quality Index in children and adolescents. Public Health Nutr 7:931–935

    PubMed  Google Scholar 

  30. Tounian P, Aggoun Y, Dubern B, Varille V, Guy-Grand B, Sidi D, Girardet JP, Bonnet D (2001) Presence of increased stiffness of the common carotid artery and endothelial dysfunction in severely obese children: a prospective study. Lancet 358:1400–1404

    Article  PubMed  CAS  Google Scholar 

  31. Trachet B, Reymond P, Kips J, Swillens A, De Buyzere M, Suys B, Stergiopulos N, Segers P (2010) Numerical validation of a new method to assess aortic pulse wave velocity from a single recording of a brachial artery waveform with an occluding cuff. Ann Biomed Eng 38:876–888

    Article  PubMed  CAS  Google Scholar 

  32. Trichopoulou A, Costacou T, Bamia C, Trichopoulos D (2003) Adherence to a Mediterranean diet and survival in a Greek population. N Engl J Med 348:2599–2608

    Article  PubMed  Google Scholar 

  33. Urbina EM, Williams RV, Alpert BS, Collins RT, Daniels SR, Hayman L, Jacobson M, Mahoney L, Mietus-Snyder M, Rocchini A, Steinberger J, McCrindle B (2009) Noninvasive assessment of subclinical atherosclerosis in children and adolescents: recommendations for standard assessment for clinical research: a scientific statement from the American Heart Association. Hypertension 54:919–950

    Article  PubMed  CAS  Google Scholar 

  34. Vanhala M, Vanhala P, Kumpusalo E, Halonen P, Takala J (1998) Relation between obesity from childhood to adulthood and the metabolic syndrome: population based study. BMJ 317:319–320

    Article  PubMed  CAS  Google Scholar 

  35. Wilkinson IB, MacCallum H, van Hupperetz PC, Thoor CJ, Cockcroft JR, Webb DJ (2001) Changes in the derived central pressure waveform and pulse pressure in response to angiotensin II and noradrenaline in man. J Physiol 530:541–550

    Article  PubMed  CAS  Google Scholar 

  36. Willum-Hansen T, Staessen JA, Torp-Pedersen C, Rasmussen S, Thijs L, Ibsen H, Jeppesen A (2006) Prognostic value of aortic pulse wave velocity as index of arterial stiffness in the general population. Circulation 113:664–670

    Article  PubMed  Google Scholar 

  37. Zebekakis PE, Nawrot T, Thijs L, Balkestein EJ, van der Heijden-Spek J, Van Bortel LM, Struijker-Boudier HA, Safar ME, Staessen JA (2005) Obesity is associated with increased arterial stiffness from adolescence until old age. J Hypertens 23:1839–1846

    Article  PubMed  CAS  Google Scholar 

Download references

Acknowledgments

The authors would like to express their thanks to Andrew Lowe from PulseCor®, Auckland, New Zealand for providing the necessary equipment (R6.5 Cardiovascular Monitor) to perform this study. This work was supported by a provision for equipment and administrative support from the Greek Hypertension Society.

Conflicts of interest

There was no conflict of interest for any of the authors in this study. The device used in this study (R6.5 Cardiovascular Monitor) was offered by PulseCor®, Auckland, New Zealand.

Author information

Authors and Affiliations

  1. 2nd Medical Department, Venizeleion General Hospital, Heraklion, Crete, Greece

    Charalampos Lydakis, Evaggelos Thalassinos & Melina Kavousanaki

  2. Department of Pediatrics, Venizeleion General Hospital, Heraklion, Crete, Greece

    Evaggelia Stefanaki & Sofia Stefanaki

  3. University of Athens, Medical School, Athens, Greece

    Danai Lydaki

  4. Aldou Manoutiou 11, 71409, Heraklion, Crete, Greece

    Charalampos Lydakis

  5. Kariotaki 22, 71409, Heraklion, Greece

    Evaggelia Stefanaki & Evaggelos Thalassinos

  6. Pitsoulaki 15, 71307, Heraklion, Greece

    Sofia Stefanaki

  7. M. Miliara 1, 71201, Heraklion, Greece

    Melina Kavousanaki

  8. Georgiou Skoula 12A, 71305, Heraklion, Greece

    Danai Lydaki

Authors
  1. Charalampos Lydakis
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Evaggelia Stefanaki
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Sofia Stefanaki
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Evaggelos Thalassinos
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Melina Kavousanaki
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Danai Lydaki
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Charalampos Lydakis.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Lydakis, C., Stefanaki, E., Stefanaki, S. et al. Correlation of blood pressure, obesity, and adherence to the Mediterranean diet with indices of arterial stiffness in children. Eur J Pediatr 171, 1373–1382 (2012). https://doi.org/10.1007/s00431-012-1735-3

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00431-012-1735-3

Keywords

Search

Navigation